1. Welfare for the Elderly Seminar Stomach and Intestinal Diseases: How to recognise them Dr Kalpesh Besherdas Consultant Gastroenterologist, Barnet & Chase Farm Hospital Sunday 12 February, 3.30 – 5.00pm BAPS Shri Swaminarayan Mandir, Neasden

3. What to worry about most?

5. Bowel cancer Oesophageal and stomach cancer Pancreatic cancer Liver cancer

6. 2003 Estimated US Cancer Cases* ONS=Other nervous system. *Excludes basal and squamous cell skin cancers and in situ carcinomas except urinary bladder. Source: American Cancer Society, 2003. Men 675,300 Women 658,800 210,816Breast 79,056Lung/bronchus 72,468Colon & rectum 39,528Uterine corpus 26,352Ovary 26,352Non-Hodgkin lymphoma 19,764Melanoma of skin 19,764Thyroid 13,176Pancreas 13,176Urinary bladder 62,238All other sites Prostate 222,849 Lung/bronchus 94,542 Colon/rectum 74,283 Urinary bladder 40,518 Melanoma of 27,012 skin Non-Hodgkin 27,012 lymphoma Kidney20,259 Oral cavity 20,259 Leukemia 20,259 Pancreas13,506 All other sites114,801 Men 675,300 Women 658,800

7. How Does Colorectal Cancer Develop?

8. Colon Polyp

9. Colon Cancer

10. Symptoms of Colorectal Cancer Time CourseSymptomsFindings EarlyNone Occult blood in stool MidRectal bleeding Change in bowel habits Rectal mass Blood in stool LateFatigue Anemia Abdominal pain Weight loss Abdominal mass Bowel obstruction

11. Bowel cancer: how to recognise it Rectal bleeding with change of bowel habit of ≥ 3 weeks duration Rectal bleeding without change in bowel habit with no obvious cause ≥ 3 weeks duration Change of bowel habit persisting for 3 weeks or more without bleeding Abdominal mass thought to be large bowel cancer Anaemia : fatigue

12. Is Colorectal Cancer Preventable? YES! Screening

13. The Programme

14. Eligibility Men and Women aged 60-69, and registered with a GP will automatically be invited to participate and offered a FOB test kit every two years Those aged 70 and over are not invited automatically but are able to request a test kit from the Hub

15. THE KIT

16. Colonoscopy

17. CT Colography Colon Polyp

18. CT Colography Colon Polyp

19. CT Colography Colon Cancer

21. Rectal Bleeding If you’ve had blood in your poo or looser poo for 3 weeks, your doctor wants to know. Chances are it’s nothing to worry about, but these symptoms could be signs of bowel cancer, so tell your doctor. Finding bowel cancer early makes it more treatable and could save your life.

23. Upper GI cancer

24. Oesophageal/Stomach cancer Indigestion or heartburn that doesn’t go away Not feeling hungry (loss of appetite) Bloating after a small amount of food Nausea and vomiting Difficulty in Swallowing Feeling very tired and lethargic (symptom of anaemia) Unexplained weight loss Blood in your vomit or faeces or black tar like faeces.

25. Oesophageal/Stomach cancer causes Obesity or a poor diet, particularly one which contains a lot of salty, pickled or processed foods Infection with an organism called Helicobacter pylori Barrett's oesophagus (where abnormal cells develop in the lining of the lower oesophagus) Pernicious anaemia (an autoimmune condition where the lining of the stomach becomes thin, less acid is produced and anaemia develops due to lack of vitamin B12), atrophic gastritis or a hereditary condition of growths in the stomach Smoking Previous surgery for peptic ulcer

26. Diagnosing stomach cancer Endoscopy Barium X-ray CT scan

27. Abdominal pain

38. Diarrhoea

41. Common causes of constipation not enough fibre in the diet not drinking enough water lack of exercise Medications irritable bowel syndrome changes in life or routine such as pregnancy, older age, and travel abuse of laxatives problems with the colon and rectum

42. Bloating

43. Cause of bloating and flatulence

44. Bloating treatment: diet

45. The End